Recovery From Surgery for Tumors of the Lateral and Third Ventricles in Children

Postoperative Orders

• Standard postcraniotomy care in ICU
• ICP monitoring: An intraventricular monitoring device combines assessment of intraventricular pressure with CSF draining to treat increased ICP, but caution in interpretation is mandatory. ICP is usually monitored for 48 hours, and the monitor is then removed at the bedside.
• EVD: The drainage bag is raised 10-12 cm above the foramen of Monro. The resistance to drainage is progressively increased, and the tube is then clamped. If the patient tolerates the clamping the EVD is then removed.
• Steroids: The initial maintenance dose is usually continued for at least 48 hours and then gradually tapered over a week.
• Postoperative imaging: Either an MRI or a CT scan is usually obtained on the first or second postoperative day to evaluate the extent of the tumor resection and to check for hemorrhage or obstruction of CSF pathways.
• Rehabilitation Medicine:  A consultation for physical therapy support is requested when needed.

Postsurgical Morbidity

• Ventriculitis: Ventriculitis is the most frequent problem.  In addition to the risk of an  infectious ventriculitis, a chemical ventriculitis is quite common due to the operative debris left within the ventricle. Bone flap infection may present as a local inflammatory reaction with suppuration or as a fistula. The standard treatment is removal of the infected bone flap.